Lips become chapped for a multitude of reasons. Wind and cold weather are two of the most common.1,2 Obstructed breathing (as in allergic rhinitis) can force patients to mouth-breathe, which also predisposes to chapped lips.3 Chapped lips may be due to allergic or irritant dermatitis from the use of topical lip products, mouthwashes, or toothpastes.4,5 Isotretinoin, a drug used to treat acne, causes mucocutaneous reactions such as cheilitis (severe chapped lips).6
Chapped lips are painful and unsightly. If they crack open, the patient can experience pain when performing normal daily activities, including eating, drinking, talking, smiling, or kissing. Furthermore, some patients with chapped lips compulsively and obsessively lick them in vain attempts to relieve the discomfort. However, this activity delivers irritant salivary and intraoral fluids to the lips, worsening the problem.4
Potential treatments for chapped lips include protectants, hydrocortisone, and products of unknown safety and efficacy, such as those containing salicylic acid. Protectants temporarily relieve chapped or cracked lips and help defend lips from the drying effects of wind and cold weather. The FDA allows protectant labeling on products that contain allantoin 0.5% to 2%, cocoa butter 50% to 100%, cod liver oil 5% to 13.56%, dimethicone 1% to 30%, glycerin 20% to 45%, hard fat 50% to 100%, lanolin 12.5% to 50%, mineral oil 50% to 100%, and petrolatum 30% to 100%.1 Two or more protectants may be combined.
Hydrocortisone 0.25% to 1% is approved by the FDA for topical application in the treatment of minor skin irritations, itching, and rashes due to various causes, e.g., eczema, dermatitis, or allergies to cosmetics, soaps, or detergents.7 Thus, it should be efficacious for many common causes of chapped lips (allergic and irritant dermatoses, repeated licking, and climate-related conditions).
Selected Nonprescription Lip Care Products
|Dimethicone 2%, octinoxate 7.5%, oxybenzone 2.5%, petrolatum, butylparaben, ethylparaben, methylparaben, propylparaben|
|Dimethicone 2%, oxybenzone 2.5%, padimate O 6.6%, camphor, cetyl alcohol, isopropyl myristate, lanolin, menthol, petrolatum, methylparaben, |
|Allantoin 1%, camphor 0.5%, menthol 0.6%, phenol 0.5%, cetyl alcohol, ammonium hydroxide, dimethicone, lanolin, stearyl alcohol |
||Menthol 0.7%, camphor 1.7%, phenol 0.4%, petrolatum, lanolin, salicylic acid (listed as an “inactive ingredient”; no concentration given), fragrance|
|Padimate O 1.5%, white petrolatum 44%, cetyl alcohol, isopropyl myristate, lanolin, menthol, methylparaben, propylparaben, fragrance|
|Camphor 1%, menthol 0.6%, petrolatum 41%, phenol 0.5%, cetyl alcohol, isopropyl myristate, lanolin, methylparaben, propylparaben, fragrance|
||Hydrocortisone 1%, beeswax, petroleum jelly, mineral oil|
||Dimethicone 1%, meradimate 5%, octinoxate 7.5%, octisalate 5%, oxybenzone 6%, hybrid sunflower oil, petrolatum, mineral oil|
||Allantoin 1.5%, pramoxine HCl 1%, petrolatum, vitamin E, propylparaben|
|Octinoxate 7.5%, oxybenzone 4%, castor seed oil, corn oil, petrolatum, beeswax, stearyl alcohol |
Some lip products contain salicylic acid, an ingredient of unproven safety when applied to lips. The FDA-approved uses of salicylic acid are the application to hypertrophied skin lesions, such as corns, calluses, and warts. Salicylic acid possesses a keratolytic action that erodes the hyperkeratotic lesions. However, lips are not hyperkeratotic skin, as found in warts.8 When salicylic acid is applied to the lips, it can erode through the outer stratum corneum to damage living skin layers beneath—this creates a vicious cycle.
The cycle begins when a patient with a minor case of chapped lips uses a salicylic acid lip product. These products often contain minor analgesics to mask the discomfort so that the patient's lips feel soothed. However, the salicylic acid causes de novo damage to the lips. When the product's analgesic effect abates, the patient perceives the new damage as a continuation of the chapped lips and uses the product again. Eventually, the patient becomes dependent on the analgesic effect of the product to combat its continuing damage to the lips, causing extended use of the product for sustained periods, possibly decades. The remedy is to stop application of the product entirely, in the hope that the damaged lips will eventually heal, replacing it with a nonirritating protectant/hydrocortisone product in the interim, if desired.
Even lip balms that do not contain salicylic acid may contain potential irritants and/or allergens. These nonprotectant ingredients include isopropyl myristate, eugenol, and phenol.
The best advice the pharmacist can give to patients with chapped lips is to:
1. Keep the tongue inside the mouth, and stop licking the lips.
2. Examine all products used on the lips to see if they might contain allergenic ingredients.
3. Stop the use of any lip product containing potentially erosive ingredients, such as salicylic acid or possible allergens/irritants that do not function as protectants.
4. Consider using a gentle lip balm containing FDA-approved protectants. To care for minor dermatoses, use a balm with hydrocortisone in a vehicle consisting only of protectants.
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1. Skin protectant drug products for over-the-counter human use: final monograph. Federal Register. 2003;68:33362-33381.
2. Shulman JD, Lewis DL, Carpenter WM. The prevalence of chapped lips during an army hot weather exercise. Mil Med. 1997;162:817-819.
3. Berger WE. Allergic rhinitis in children: diagnosis and management strategies. Paediatr Drugs. 2004;6:233-250.
4. Agar N, Freeman S. Cheilitis caused by contact allergy to cocamidopropyl betaine in '2-in-1 toothpaste and mouthwash.' Australas J Dermatol. 2005;46:15-17.
5. Strauss RM, Orton DI. Allergic contact cheilitis in the United Kingdom: a retrospective study. Am J Contact Dermat. 2003;14:75-77.
6. Charakida A, Mouser PE, Chu AC. Safety and side effects of the acne drug, oral isotretinoin. Expert Opin Drug Saf. 2004;3:119-129.
7. Hydrocortisone; marketing status as an external analgesic drug product for over-the-counter human use; notice of enforcement policy. Federal Register. 1991;56:43025-43026.
8. Kobayashi H, Tagami H. Functional properties of the surface of the vermilion border of the lips are distinct from those of the facial skin. Br J Dermatol. 2004;150:563-567.